The presence of combined joint contractures, the development of secondary protrusive coxarthritis (PC), severe osteoporosis and bone destruction in patients with rheumatoid arthritis (RA) and spondyloarthritis produce a number of technical difficulties during the implementation of total hip arthroplasty (THA). In this article we have presented a clinical case of bilateral cementless THA performed in a patient with RA and secondary PC. Before surgery the functional Harris score was 20 points, and the DA-S28 (disease activity score) was 3.1. The patient had PC of the third degree on the right and the second degree on the left side. During THA on the right side we applied the technique of impact bone autoplasty. Four years after surgery, the functional Harris score was 73; DAS‑28 was 2.7. Thus, the combination of conservative therapy and surgical treatment improves patient's clinical and functional state and also helps to maintain low activity of RA.
Introduction The systemic nature of the disease and the use of modern conservative therapy may cast doubt on the effectiveness and necessity of total hip arthroplasty (THA) in ankylosing spondylitis (AS). A comprehensive assessment of the functional state, quality of life (QOL) and subjective assessment of patients allows the most complete analysis of treatment results. Objective Comprehensive analysis of short-term results of quality of life, clinical and functional status and treatment satisfaction in patients with AS after THA. Materials and methods 17 patients with AS underwent primary THA (5 women, 12 men, average age 43.8 ± 3.1; from 33 to 52 years). Cases of complete bone ankylosis of the hip joint were excluded. An analysis of the functional state using Harris Hip Score and QOL (SF-36v2) was performed before surgery, 2 months, 6 months and 12 months after surgery. Patient treatment satisfaction analysis (VAS) was performed at the same follow-ups. Results A significant improvement in clinical and functional status (HHS) and QOL (SF-36v2) was obtained after 2, 6, 12 months compared with the preoperative level (p < 0.05). High levels of patient satisfaction with treatment outcomes were achieved. Para-articular ossification (3 patients, 18 %), a hematoma in the postoperative wound area (1 patient, 6 %), implant dislocation (1 patient, 6 %) were the main complications. Conclusion THA in patients with AS improves not only the functional state but also the QOL compared with the preoperative level.
A comparative analysis of the clinical, functional and radiological results of total hip arthroplasty (THA) in pts with primary osteoarthritis (PA) was carried out. The aim was to improve the results of THA in pts with degenerative diseases of the hip joint based on the choice of the optimal type of components fixation. The study included 125 patients (68 women, 57 men) with primary coxarthritis who underwent 125 operations of unilateral THA. All pts were divided into two groups depending on the type of components fixation. Group I (N = 63; average age 69.8 ± 3.1; from 34 to 75 years) included pts with cementless fixation (DePuy, Zimmer, titanium cups, titanium stems such as Corail and Zweymuller), in group II (N = 62; average age 67.2 ± 2.7; from 44 to 87 years) — with cement fixation (Zimmer, Smith & Nephew — low-profile Muller cup, Muller stem). Metal-polyethylene friction pair and head size 32 mm were used in all cases. Evaluation of the results was carried out on 2, 6 months, 1, 5, 10 years after the operation and included: functional state assessment (Harris Hip Score), radiographs analysis, as well as the frequency of complications and revision interventions. There were no significant differences in the incidence of deep periprosthetic infection, thromboembolic complications, hematomas, paraarticular ossifications, aseptic loosening, dislocations and revision interventions. There was faster positive dynamics in the early period (up to 6 months) when using cemented THA. Subsequently all the indicators were comparable in both groups. Osteolysis at the border of implant fixation was recorded in two cases in group I and in 11 cases in group II (p < 0,05). In group I, eight periprosthetic intraoperative fractures of the proximal hip were recorded; in group II, this complication was obtained in one pt (p < 0.05). Stress-shielding syndrome was detected in six pts from group I. This complication was not detected in group II (p < 0.05). Thus, both methods are comparable in results and can be equally applicable for the surgical treatment of patients with primary osteoarthritis, which can significantly expand the possibilities of specialized medical care and effective rehabilitation of this category of patients.
Aim of the research – to evaluate the effectiveness, to analyze the complications and long-term results of total hip arthroplasty (THA) in patients with active psoriatic arthritis (PsA).Materials and methods. The results of THA were studied in 26 patients with PsA (19 men, 7 women; average age 54.8±3.1 years, from 38 to 56 years) up to 2 years after surgery. The diagnosis of PsA was established according to CASPAR criteria.Results. The visual analogue scale assessment showed a significant decrease in the intensity of pain in the hip joint in the postoperative period. The average DAPSA activity index before surgery was 25.9 (11–34), after 2 months – 31.3 (16–38), after 6 months – 30.5 (12–37), with a further decrease to 26.1 (12–35) by 24th month. The results of clinical and functional assessment according to Harris in 19 (73%) patients corresponded to an excellent level, in 7 (27%) – to a good level. No infectious, thromboembolic complications were detected. In 1 (4%) patient periprosthetic intraoperative fracture of the femur was diagnosed No new skin psoriatic elements in the field of surgical intervention was fixed.Conclusion. Our data indicate the effectiveness of THA in active PsA, provided that the requirements for careful planning of the intervention, prevention of possible complications and an individualized approach to rehabilitation are met.
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